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Form MC14 A Qualified Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individual (Qi) Application - California (Ukrainian)
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Ukrainian. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is an MC14 A form?
A: MC14 A form is an application form for Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs in California.
Q: What are the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs?
A: The QMB, SLMB, and QI programs are state programs that help low-income individuals pay for their Medicare premiums and cost-sharing.
Q: Who is eligible for QMB, SLMB, and QI programs?
A: Low-income individuals who meet the income and resource limits set by the state are eligible for these programs.
Q: What is the purpose of the MC14 A form?
A: The MC14 A form is used to apply for QMB, SLMB, and QI programs in California.
Form Details:
- Released on July 1, 2022;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form MC14 A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC14 A Qualified Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individual (Qi) Application - California (Ukrainian)
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